Oxygenation Flashcards
thin, double-layered pleural membrane is disrupted by lung disease, surgery, or trauma
CHEST TUBES AND DRAINAGE SYSTEMS
excess fluid in pleural space
pleural effusion
accumulation of blood in pleural space
hemothorax
air collects in the pleural space
pneumothorax
-when client inhales, water prevents air from entering system from the atmosphere.
-During exhalation air can exit the chest cavity, bubbling up through the water.
-Suction can be added to facilitate removing air and secretions from the chest cavity.
water-seal system
-always kept below the level of the client’s chest
-prevent fluid and drainage from being drawn back into the chest cavity.
drainage system
- used for ambulatory clients.
-one-way flutter valve
-allows air to escape from chest cavity, but prevents air from reentering.
-No collection chamber
Heimlich valve
-one-way valve and
-Has a small built-in collection chamber
-for clients with a pneumothorax
Pneumostat
If air cannot escape
tension pneumothorax.
T/F: When transporting and ambulating the client you should keep water-seal unit above chest level & upright.
False. keep water-seal unit below chest level & upright.
crackling sound
subcutaneous emphysema.
The process of gas exchange between the individual and the environment
Respiration
Movement of air in and out of the lungs
Ventilation or breathing
Diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
Alveolar-capillary gas exchange
What are the four processes of the respiratory system?
- Pulmonary ventilation
- Alveolar gas exchange
- Transport of oxygen and carbon dioxide
- Systemic diffusion
What are the parts of the upper respiratory system?
Mouth
Nose
Pharynx
Larynx
What are the parts of the lower respiratory system?
Trachea
Lungs
- Bronchi
- Bronchioles
- Alveoli
- Pulmonary capillary network
- Pleural membranes
Which part warms, humidifies, and filters air?
Nose
What traps large particles in the air?
Hairs
What is initiated when irritants pass in the nasal passages?
Sneeze reflex
What is the shared pathway for air and food?
Pharynx
Richly supplied with lymphoid tissue that traps and destroys pathogens entering with the air
Nasopharynx
Oropharynx
What is important for maintaining airway patency and protecting the lower airways from swallowed food?
Larynx
What opens during breathing, allowing air to move freely into the lower airways?
Epiglottis
What leads to the left and right main bronchi?
Trachea
Where does gas exchange occur?
Respiratory bronchioles and alveoli
What does the alveolar and capillary walls from?
Respiratory membrane (also known as the alveolar-capillary membrane)
What is essential to normal gas exchange?
The thin, highly permeable membrane of the respiratory membrane
Thus, fluid or other materials in the alveoli interfere with the respiratory process.
What covers the outer surface of the lungs?
A thin, double layer of tissue known as the pleura
What lines the thorax and surface of the diaphragm?
Parietal pleura
What covers the external surface of the lungs?
Visceral pleura
What is between the pleural layers that is a potential space containing a small amount of pleural fluid?
A serous lubricating solution
This prevents friction during the movements of breathing and serves to keep the layers adherent through its surface tension
What is the first process of the respiratory system?
Ventilation of the lungs
Air flows into the lungs
Inspiration (inhalation)
Air flows out of the lungs
Expiration (exhalation)
What factors does adequate ventilation depend on?
- Clear airways
- An intact central nervous system (CNS) and respiratory center (medulla and pons in the brainstem)
- An intact thoracic cavity capable of expanding and
contracting - Adequate pulmonary compliance and recoil
What is the degree of chest expansion during normal breathing, requiring little energy expenditure?
Tidal volume
In adults, approximately 500 mL of air is inspired and expired with each breath.
Clients with obstructive pulmonary disease exhibit what?
Active use of accessory muscles of respiration and noticeable effort in breathing
What is the expansibility or stretchability of lung tissue that plays a significant role in the ease of ventilation?
Lung compliance
What is the term for the collapse of a portion of a lung?
Atelectasis
What is the continual tendency of the lungs to collapse away from the chest wall?
Lung recoil
What is a lipoprotein produced by specialized alveolar cells that reduces the surface tension of alveolar fluid?
Surfactant
What is the movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration?
Diffusion
What is the oxygen-carrying red pigment in the red blood cells?
Hemoglobin
What is the compound of oxygen and hemoglobin that is carried to the tissues?
Oxyhemoglobin
Enumerate the factors that affect the rate of oxygen transport from the lungs and tissues.
- Cardiac output
- Number of erythrocytes and blood hematocrit
- Exercise
T/F: Any pathologic condition that decreases cardiac output (e.g., damage to the heart muscle, blood loss, or pooling of blood in the peripheral blood vessels) diminishes the amount of oxygen delivered to the tissues.
T
What is the percentage of the blood that is erythrocytes?
Hematocrit
What are the normal values of hematocrit for men and women?
40% - 54% in men
37% - 50% in women
What is the fourth process of respiration?
Systemic diffusion
T/F: Carbon dioxide concentrations play a major role in regulating respiration in clients with chronic lung ailments such as emphysema.
F
Oxygen concentrations, not carbon dioxide concentrations
T/F: Oxygen is considered a drug and must be carefully prescribed based on individual client conditions
T
What are the factors affecting respiratory function?
- Age
- Environment
- Lifestyle
- Health status
- Medications
- Stress
What are the changes associated with aging that affect the respiratory system of older adults?
- Chest wall and airways become more rigid and less elastic.
- The amount of exchanged air is decreased.
- The cough reflex and cilia action are decreased.
- Mucous membranes become drier and more fragile.
- Decreases in muscle strength and endurance occur.
- If osteoporosis is present, adequate lung expansion
may be compromised. - A decrease in efficiency of the immune system occurs.
- Gastroesophageal reflux disease is more common in
older adults and increases the risk of aspiration. The aspiration of stomach contents into the lungs often causes bronchospasm by setting up an inflammatory response.
T/F: The higher the altitude, the lower the PO2 an individual breathes
T
T/F: Sedentary individuals have the alveolar expansion and deep-breathing patterns of individuals with regular activity and are more able to respond effectively to respiratory stressors.
F
Sedentary individuals lack the alveolar expansion and deep-breathing patterns of individuals with regular activity and are less able to respond effectively to respiratory stressors.
T/F: Certain occupations predispose an individual to lung disease
T
T/F: In the healthy individual, the respiratory system can pro- vide sufficient oxygen to meet the body’s needs. Diseases of the respiratory system, however, can adversely affect the oxygenation of the blood.
T
T/F: All of medications can decrease the rate and depth of respirations.
F
A variety of medications can decrease the rate and depth of respirations.
What are the most common medications that affect the rate and depth of respirations?
- Benzodiazepine sedative–hypnotics and antianxiety drugs (e.g., diazepam [Valium], lorazepam [Ativan], midazolam [Versed])
- Barbiturates (e.g., phenobarbital)
- Opioids such as morphine
T/F: Newborn clients are at high risk of respiratory depression and usually require reduced dosages.
F
Older clients are at high risk of respiratory depression and usually require reduced dosages.
T/F: When stress and stressors are encountered, both psychologic and physiologic responses can affect oxygenation.
T
What is released during stress that causes the bronchioles to dilate, increasing blood flow and oxygen delivery to active muscles?
Epinephrine
Respiratory function can be altered by conditions that affect:
- Patency (open airway)
- The movement of air into or out of the lungs
- The diffusion of oxygen and carbon dioxide between
the alveoli and the pulmonary capillaries - The transport of oxygen and carbon dioxide via the
blood to and from the tissue cells
T/F: Lower airway obstruction involves partial or complete occlusion of the passageways in the bronchi and lungs most often due to increased accumulation of mucus or inflammatory exudate.
T
What does a low-pitched snoring sound during inhalation indicate?
Partial obstruction of the upper airway passages
What does an extreme inspiratory effort that produces no chest movement and an inability to cough or speak indicate?
Complete obstruction
What does stridor, a harsh, high-pitched sound, heard during inspiration indicate?
Lower airway obstruction
Normal respiration
Eupnea
Rapid respirations
Tachypnea
Abnormally slow respiratory rate
Bradypnea
Absence of any breathing
Apnea
Inadequate alveolar ventilation that may be caused by either slow or shallow breathing, or both
Hypoventilation
Hypoventilation may lead to increased levels of carbon dioxide. What is the term for this?
Hypercarbia or hypercapnia
Hypoventilation may lead also lead to low levels of oxygen. What is the term for this?
Hypoxemia
What is the inability to breathe easily unless sitting upright or standing?
Orthopnea
What is the feeling of being short of breath or having difficulty breathin?
Dyspnea
What is the term for reduced oxygen levels in the blood?
Hypoxemia
What is the term for insufficient oxygen anywhere in the body?
Hypoxia
What is the term for bluish discoloration of the skin, nail beds, and mucous membranes due to reduced hemoglobin and decreased oxygen saturation?
Cyanosis
What is the coughed-up material that is relevant in obtaining nursing history?
Sputum
T/F In assessing a client’s oxygenation status, the nurse uses all four physical examination techniques: inspection, palpation, percussion, and auscultation.
T
What are included in diagnostic tests to assess respiratory status, function, and oxygenation?
- sputum specimens
- throat cultures
- visualization procedures
- venous and arterial blood specimens
- pulmonary function tests
What test measures lung volume and capacity?
Pulmonary function tests
Give examples of nursing diagnoses for clients with oxygenation problems.
- altered respiratory status
- altered breathing pattern
- altered gas exchange
- inadequate physical energy for activities
Give example outcomes or goals for clients with oxygenation problems.
- Maintain a patent airway.
- Improve comfort and ease of breathing.
- Maintain or improve pulmonary ventilation and oxygenation.
- Improve the ability to participate in physical activities.
- Prevent risks associated with oxygenation problems such as skin and tissue breakdown, syncope, acid–base imbalances, and feelings of hopelessness and social isolation.
Volume inhaled and exhaled during normal quiet breathing
Tidal volume (VT)
Maximum amount of air that can be inhaled over and above a normal breath
Inspiratory reserve volume (IRV)
Maximum amount of air that can be exhaled following a normal exhalation
Expiratory reserve volume (ERV)
The amount of air remaining in the lungs after maximal exhalation
Residual volume (RV)
The total volume of the lungs at maximum inflation; calculated by adding the VT, IRV, ERV, and RV
Total lung capacity (TLC)
Total amount of air that can be exhaled after a maximal inspiration; calculated by adding the VT, IRV, and ERV
Vital capacity (VC)
Total amount of air that can be inhaled following normal quiet exhalation; calculated by adding the VT and IRV
Inspiratory capacity
The volume left in the lungs after normal exhalation; calculated by adding the ERV and RV
Functional residual capacity (FRC)
The total volume or amount of air breathed in 1 minute
Minute volume (MV)
Give example nursing interventions to facilitate pulmonary ventilation
- ensuring a patent airway
- positioning
- encouraging deep breathing and coughing
- ensuring adequate hydration
- suctioning
- lung inflation techniques
- administration of analgesics before deep breathing and coughing
- postural drainage
- percussion and vibration
T/F: Changing position frequently, ambulating, and exercising usually maintain adequate ventilation and gas exchange.
T
Interventions by the nurse to maintain the normal respirations of clients include:
- Positioning the client to allow for maximum chest expansion
- Encouraging or providing frequent changes in position
- Encouraging deep breathing and coughing
- Encouraging ambulation
- Implementing measures that promote comfort, such as
giving pain medications
What position allows maximum chest expansion in clients who are confined to bed?
semi-Fowler’s or high-Fowler’s position
T/F: Clients with severe pneumonia or other pulmonary disease in one lung, if positioned laterally, should be generally positioned with the “good lung down” to improve diffusion of oxygen to the blood from function- ing alveoli.
T
Dyspneic clients often sit in bed and lean over their overbed tables (which are raised to a suitable height), usually with a pillow for support.
T
This orthopneic position is an adaptation of the high-Fowler’s position.
T/F: When coughing raises secretions high enough, the client may either expectorate (spit out) or swallow them.
T
T/F: Swallowing the secretions is harmful but it allows the nurse to view the secretions for documentation purposes or to obtain a specimen for testing.
F
Swallowing the secretions is not harmful but does not allow the nurse to view the secretions for documentation purposes or to obtain a specimen for testing.
What are devices that add water vapor to inspired air?
Humidifiers
What are some medications that may be used to treat respiratory problems?
Bronchodilators, anti-inflammatory drugs, leukotriene modifiers, expectorants, and cough suppressants
What medication reduce bronchospasm, opening tight or congested airways and facilitating ventilation?
Bronchodilators
What medication works by decreasing the edema and inflammation in the airways and allowing a better air exchange?
Anti-inflammatory drugs
What medication decreases the effects of leukotrienes on the smooth muscle of the respiratory tract?
Leukotriene modifiers
What medication helps “break up” mucus, making it more liquid and easier to expectorate?
Expectorants
What medication acts directly on the heart to improve the strength of contraction and slow the heart rate?
Digitalis glycosides
What medication increases cardiac output, thus improving oxygen transport
Beta-adrenergic stimulating agents
What medication affects the sympathetic nervous system to reduce the workload of the heart?
Beta-adrenergic blocking agents
What is the forceful striking of the skin with cupped hands?
Percussion
T/F: Percussion over congested lung areas can mechanically dislodge tenacious secretions from the bronchial walls.
T
Clients with diabetes mellitus should avoid cough syrups that contain _________.
sugar or alcohol
What is the series of vigorous quiverings produced by hands that are placed flat against the client’s chest wall?
Vibration
Vibration is used after ______ to increase the turbulence of the exhaled air and loosen thick secretions.
Percussion
What is the drainage by gravity of secretions from various lung segments?
Postural drainage
Obstruction of the smaller airways results to _____.
Atelectasis
What lobes require drainage?
Lower lobes
T/F. The best times for postural drainage treatment include before breakfast, before lunch, in the late afternoon, and before bedtime.
T
It is used for clients with excessive secretions such as with cystic fibrosis, COPD, and bronchiectasis.
Mucus Clearance Device (MCD)
A small, handheld device with a hard plastic mouthpiece at one end and a perforated cover at the other end.
Flutter MCD
_____ gases dehydrate the respiratory mucous membranes
Dry
It is attached below the flow meter gauge.
Humidifier bottle
Prevents mucous membranes from drying and becoming irritated and loosen secretions for easier expectoration.
Humidifier
T/F. The more bubbles created during this process (oxygen passing through water), the less water vapor is produced.
F
